Ophthalmic Manifestations of Coronavirus Disease 2019 and Ocular Side Effects of Investigational Pharmacologic Agents

Daniel J. Olson; Arko Ghosh; Alice Yang Zhang


Curr Opin Ophthalmol. 2020;31(5):403-415. 

In This Article

Abstract and Introduction


Purpose of Review: To compile and report the ocular manifestations of coronavirus disease 2019 (COVID-19) infection and summarize the ocular side effects of investigational treatments of this disease.

Recent Findings: Conjunctivitis is by far the most common ocular manifestation of COVID-19 with viral particles being isolated from tears/secretions of infected individuals. Multiple therapeutic options are being explored across a variety of medication classes with diverse ocular side effects.

Summary: Eye care professionals must exercise caution, as conjunctivitis may be the presenting or sole finding of an active COVID-19 infection. While no currently studied therapeutic agents have been found to reliably treat COVID-19, early vaccination trials are progressing and show promise. A video abstract is available for a more detailed summary.

Video abstract: http://links.lww.com/COOP/A36.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for coronavirus disease 2019 (COVID-19). It is estimated that this novel RNA virus emerged in November 2019 and began to spread rapidly in Wuhan, China.[1,2] The first hospitalization for this novel strain of coronavirus was thought to have occurred on December 16, with diagnosis through metagenomic massive parallel sequencing of a bronchoalveolar lavage sample.[3,4] Patients presented with fever, cough, rhinorrhea, malaise, and in more severe cases, dyspnea and respiratory distress with characteristic findings on chest radiography and computerized tomography.[5] SARS-CoV-2 has continued to spread globally in pandemic proportions, infecting a confirmed number of 11,256,672 individuals in 215 countries with likely thousands of undiagnosed cases, claiming the lives of 530,263 individuals.[6]

SARS-CoV-2 belongs to the human coronavirus family, which is comprised of enveloped, positive sense, single-stranded RNA viruses. These viruses utilize the angiotensin-converting enzyme-2 (ACE2) receptor to facilitate infection of host cells.[7] ACE2 is found on cells of numerous tissues throughout the human body, including the alveolar lung mucosa, kidneys, oral mucosa, gastrointestinal tract, and the conjunctival mucosa.[8,9] Other recent human coronavirus outbreaks include SARS-CoV in 2003 and Middle Eastern respiratory syndrome coronavirus.[10] SARS-CoV-2 shares 82% nucleotide identity with SARS-CoV.[11] As the SARS-CoV crisis was ending, a new coronavirus, HCoV-NL63, was isolated and was found to be rarely associated with conjunctivitis.[12,13] These viruses are thought to be transmitted primarily via droplet, aerosols, and direct contact,[14] though the virus has been isolated from feces,[15] tears, and conjunctival secretions as well.[9,16–20] It is unclear if conjunctival sections or tears pose a significant risk of disease transmission. However, precautions should be taken by all eye care professionals to protect against this threat. Raboud et al.[21] found that during the 2003 SARS outbreak that only 1% of Canadian healthcare workers who wore protective eyewear were infected while caring for SARS patients while 8% were infected that did not wear eye protection (odds ratio 7.34).